CALCANEUS WEIGHT-BEARING COALITION POSITION
PP: Upright; posterior surface of heel at edge of
AXIAL PROJECTION IR; unaffected foot one step forward (to prevent
superimposition of leg shadow)
[Plantodorsal Projection]
RP: Level of 5th MT base
PP: Supine/Seated; leg fully extended; dorsiflex
foot w/ strip of gauze; foot ┴ to IR CR: 45 degrees anteriorly
RP: 3rd MT base SS: Calcaneotalar coalition
CR: 40 degrees cephalad to long axis of foot
SS: Calcaneus & subtalar joint
LATERAL PROJECTION
[Mediolateral Projection]
AXIAL PROJECTION PP: Supine; patient turn toward affected side;
plantar surface // to IR
[Dorsoplantar Projection]
RP: 1 inch distal to medial malleolus (at subtalar
PP: Prone; ankle elevated; dorsiflex ankle; foot ┴ joint)
to IR; IR vertical
CR: ┴
RP: Dorsal surface of ankle joint
SS: Calcaneus & ankle joint; sinus tarsi
CR: 40-degree caudad
SS: Calcaneus, subtalar joint & sustentaculum tali
NOTE; CT is usually used to demonstrate
calcaneus
WEIGHT BEARING METHOD
[LATEROMEDIAL OBLIQUE PROJECTION]
PP: Upright; leg perpendicular to IR; calcaneus
center to IR
RP: Lateral malleolus
CR: 45-degree caudad (medially)
SS: Calcaneal tuberosity
LILIENFELD METHOD
ER: Useful in diagnosing stress fractures of
(DORSOPLANTAR AXIAL PROJECTION) calcaneus or tuberosity
SUBTALAR JOINT
PA AXIAL OBLIQUE PROJECTION
[Lateral Rotation] BRODEN METHOD
PP: Lateral position; patient lie on affected side, [AP AXIAL OBLIQUE PROJECTION]
heel elevated 1.5 inches (3.8 cm) from exact
lateral position; ball of foot (metatarsophalangeal Lateral Rotation
area) angled 25 forward PP: Supine; leg & foot rotated 45 degrees
RP: Ankle joint laterally. dorsiflex foot; foot rested against 45
degrees foam wedge
CR: 5 anterior & 23 degree caudad
RP: 2 cm distal & 2 cm anterior to medial
SS: Middle and posterior articulation malleolus
CR: 15 degrees cephalad
SS: Posterior articulation
ER: To determine the presence of joint
involvement in cases of comminuted fracture
BRODEN METHOD
[AP AXIAL OBLIQUE PROJECTION]
Medial Rotation
PP: Supine; leg & foot rotated 45 degrees
medially; dorsiflex foot (to obtain right angle
flexion); foot rested against 45-degree foam
wedge
RP: 2-3 cm caudoanteriorly to lateral malleolus
CR: 10, 20, 30 or 40 degrees cephalad
SS: Posterior articulation ISHERWOOD METHOD
• Anterior portion (40 degree) (FEIST-MANKIN METHOD)
(LATEROMEDIAL OBLIQUE PROJECTION)
• Posterior portion (10 degree)
• Talus & sustentaculum tali articulation (20-30
Medial Rotation Foot
degree)
PP: Semi supine; foot & leg rotated 45 degrees SS: Posterior subtalar articular surface
medially; knee flexed; 45 degrees foam wedge
under elevated leg ANKLE
RP: 1 inch. distal & 1 inch. anterior to lateral AP PROJECTION
malleolus
PP: Supine; leg & foot vertical & rotated 5
CR: ┴ degrees medially (places malleoli equidistant)
SS: Anterior subtalar articular surface RP: Point midway between malleoli
• Oblique projection of tarsals CR: ┴ to ankle joint
SS: Ankle joint & tibiotalar joint space
• True AP: inferior tibiofibular & talofibular
articulations not in profile (normal)
LATERAL
ISHERWOOD METHOD PROJECTION
(FEIST-MANKIN METHOD) Mediolateral Projection
(AP AXIAL OBLIQUE PROJECTION) PP: Semi supine; lateral surface of foot against
IR; dorsiflex foot (prevent lateral rotation of the
ankle)
Medial Rotation Ankle
RP: Medial malleolus
PP: Seated or semi-lateral recumbent (more
comfortable); leg, foot & ankle rotated 30 degrees CR: ┴ to ankle joint
medially; dorsiflex foot; 30 degrees foam wedge SS: True lateral projection of lower third of tibia
RP: 1 inch. Distal & 1 inch. Anterior to lateral & fibula, ankle joint & tarsals
malleolus • 5th metatarsal base (identify Jones fx)
CR: 10 degrees cephalad • Tibiotalar joints (well visualized)
SS: Middle subtalar articular surface & “end on”
projection of sinus tarsi LATERAL PROJECTION
Lateromedial Projection
PP: Semi supine; medial surface of foot against
IR; dorsiflex foot
RP: 0.5 in. superior to lateral malleolus
CR: ┴ to ankle joint
Lateral Rotation Ankle SS: Lateral projection of lower third of tibia &
PP: Supine/seated; leg, foot & ankle rotated 30 fibula, ankle joint & tarsals Exact positioning of
degrees laterally, dorsiflex foot ankle is more easily & more consistently obtained
RP: 1 inch. Distal medial malleolus
CR: 10 degrees cephalad
Medial Rotation
PP: Supine; Leg & foot rotated 15-20 degrees
medially (intermalleolar line // to IR); plantar
surface right angle to leg
RP: Point midway b/n malleoli
AP OBLIQUE CR: ┴ to ankle joint
PROJECTION SS: Mortise joints (three sides must be visualized)
Medial Rotation
PP: Supine; leg & foot rotated 45degree laterally;
dorsiflex foot
RP: Point midway b/n malleoli
CR: ┴ to ankle joint
SS: Distal ends of tibia & fibula (often
superimposed over talus) STRESS METHOD
• tibiofibular articulation (AP PROJECTION)
Taken after an inversion & eversion injury
PP: Seated; foot forcibly turned toward the
opposite side
RP: Ankle joint
CR: ┴
ER: To
AP OBLIQUE PROJECTION evaluate the
Lateral Rotation presence of
ligamentous
PP: Supine; leg & foot rotated 45 degrees tear & joint
laterally; dorsiflex foot separation (widening of the joint space)
RP: Point midway b/n malleoli
CR: ┴ to ankle joint WEIGHT-BEARING METHOD
SS: Superior aspect of calcaneus; subtalar joint (AP PROJECTION)
ER: Useful in determining fxs PP: Upright; heels against the IR; IR vertical; toes
pointing toward the x-ray tube
RP: Midway at level of ankle joint
CR: Horizontal
ER: Identify ankle joint space narrowing; side-to
side comparison of joint
MORTISE JOINT
(AP OBLIQUE PROJECTION)
AP OBLIQUE PROJECTION
Medial/Lateral Rotation
PP: Supine; leg & foot rotated 45 degrees
LEG medially or laterally
RP: Midshaft
AP PROJECTION
CR: ┴
PP: Supine; femoral condyles // to IR; foot in
vertical position SS: Medial rotation:
RP: Midshaft • Proximal and distal tibiofibular articulation
CR: ┴ • maximum interosseous space b/n tibia and fibula
SS: Tibia & fibula; ankle & knee joints Lateral Rotation: Fibula superimposed by lateral
portion of tibia
LATERAL PROJECTION
Mediolateral Projection
PP: Supine; RPO/LPO; patella ┴ to IR; femoral
condyles ┴ to IR;
RP: Midshaft
CR: ┴
SS: Tibia & fibula; ankle & knee joints Cross-
table lateral if patient cannot be positioned in
supine
